The purpose of this study was to compare arousal levels and stress response across menstrual cycle phases in women with three perimenstrual symptom patterns. Women with low symptom severity (LS, N = 28), were compared with those with a premenstrual syndrome (PMS, N = 15) and premenstrual magnification (PMM, N = 19) pattern across postmenses and premenses phases. Each woman was assessed during relaxation and in response to mental task and symptom imaging stressors during a postmenses and premenses day. Results of baseline skin conductance (SCL), electromyogram (EMG), and finger temperature (T) demonstrated arousal premenses in women with the PMS pattern, but not in women with the LS pattern. In addition, women with the PMS pattern experienced increased EMG and SCL response to stressors premenses. Women with the PMM pattern experienced a rise in finger temperature premenses, opposite the pattern of the women with LS or PMS. These results support development of symptom management strategies to reduce arousal and modulate stress response for women with PMS who seek help for their symptoms. In addition, the difference in arousal and stress response observed in women with PMS and PMM support development of different symptom management strategies for these two groups of women.